Administratives
02.07.2001
INTERINSTITUTIONS, TOUS LIEUX D'AFFECTATION + pensionnés et écoles européennes
Sommaire
| Informations Administratives 02.07.2001 | N° 61-2001 INTERINSTITUTIONS, TOUS LIEUX D'AFFECTATION + pensionnés et écoles européennes |
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 WHAT TO DO IN THE EVENT OF ACCIDENT OR ILLNESS DURING YOUR HOLIDAYS? SOME PRECAUTIONS TO TAKE
Medical bills that you settle on the spot must be sent to the appropriate Settlements Office, together with the relevant supporting documents and proof of payment. The costs will then be reimbursed up to the maximum level, in the same way as the reimbursement of standard medical expenses. If you need to be hospitalised, first of all call on your travel insurance company, if you have one. In fact, these companies pay all the costs on the spot while the JSIS only pays directly if you are in hospital for at least two nights. To obtain a letter of direct billing from the JSIS; contact your Settelements Office:
For those people (spouses, children, ...) who have their primary insurance with a national system, find out before you leave about the procedures to be followed in case of treatment in another country (for example the E111 form for EU member states, some other document in case of a bilateral agreement, etc ...). The cost of medicine is so high in some countries (USA, Japan, South American, etc.) that even after the sickness scheme's reimbursement, you could be left with a very large amount to pay yourself. This is obvious for those expenses subjected to a maximum reimbursable amount, but is also true for those whose reimbursements are not limited by the Sickness Rules (for example X-ray costs, laboratory analyses, certain hospitalisation costs, etc). In these cases, the reimbursements could be limited by the Settlements Office to the tariffs pratised in Europe. A special reimbursement (cf. Article 72§3 of the Staff Regulations) is foreseen when these expenses reach a certain level, but some are not taken into consideration during the calculation of this reimbursement. If you are hospitalised for at least two days, you are advised to pay nothing directly to the hospital, but to ask for a letter of direct billing. If you plan to stay in one of these expensive countries, you are advised to take out extra insurance in accordance with your personal situation. If you fall sick or have an accident while outside your country of residence, the cost of your transport home is never reimbursed by the sickness insurance scheme (except under certain conditions for people posted outside the Community). To cover such eventualities it is advisable to take out private travel insurance (for example, from your credit card providers, if you have paid for your trip in this way). The coverage provided by the sickness insurance scheme is limited exclusively to transport costs in emergencies caused by sickness or accident (road accidents, sporting accidents, etc.), regardless of the type of transport used (ambulance, helicopter, etc.). The scheme covers only the cost of the journey from the place where you are staying or where the accident happened to the nearest hospital, and the cost of a transfer to the nearest hospital with the correct equipment for treating you if this hospital cannot provide the appropriate treatment. The cost of travel back home is not generally reimbursed. If you fall ill, have an accident or are hospitalised, we advise you to first contact your private insurance company. In this way, if you need medical care during your stay abroad, the cost will generally be settled directly by your private insurers. In fact, in most cases, private insurance companies will pay your bills for you and will later recuperate from the Settlements Office the amount it would have reimbursed you, without you making any payment at all. All serving officials and temporary officials have world-wide coverage for accidents both at the workplace and in their private life, with the exception of those resulting from sports regarded as dangerous (aeronautic or aerial sports such as parachuting, paragliding, hot-air ballooning, ultra-light motor planes, hang gliding and bungee jumping), martial arts and combat sports (such as boxing, karate and wrestling), speleology, underwater fishing, etc. As this list is not exhaustive, please contact the Accident Sector of the Sickness Insurance Scheme if you are in any doubt. Members of the families of officials and temporary officials, and retired officials are excluded from such coverage. However the medical expenses incurred by accidents involving these people will be reimbursed by the sickness insurance scheme on the same conditions and at the same rates as for standard medical expenses. In all cases, if the accident is the fault of a third party, you should send a note to the Accident Sector, recounting the details, as well as giving the contact details of the person(s) responsible. The sickness scheme will claim back from the person responsible any reimbursements it has had to make. The accident declaration form is available on the Institutions' intranet at the following address: http://www.europateam.cc.cec/guide/assmal/formulaire/formulaires.htm . This form must be sent within ten working days of the date on which the accident occurred to the following address: For officials of the Commission, the Agencies, the Court of Auditors, the Committee of the Regions and the Economic and Social Committee:
If you suffer an accident and are not able to have the doctor who provides the initial treatment fill out an accident declaration form, you can send in the declaration form and, at a later date, submit the initial accident report, completed and signed by your doctor and specifying the nature of the injuries, your previous medical history where relevant to the injuries and the probable medical consequences of the accident. If you were examined on the spot (X-rays, CT scanner, etc.), ask for a copy of the report to send in for your file (and keep the pictures yourself). In the event of sickness or accident during your holiday, you must notify both the Medical Service at your institution and your department. If you are sick while on annual leave, you can recuperate these leave days by faxing to your Medical Service a copy of your medical certificate which should indicate the beginning (and if possible the end) date(s) of your illness. This should be done during the first few days of your illness. Mention also the address where you are staying. The precise rules in this respect (documents to be submitted, timescale permitted) may vary slightly from Institution to Institution.
A sickness insurance carnet is available to those fully covered by the Joint Sickness Insurance Scheme (JSIS) and may be used as proof of membership of the Scheme. It is not in any sense an undertaking by the JSIS to pay for treatment - a letter confirming that the Scheme is willing to accept direct billing must still be provided for the hospital concerned. (voir ci-dessus). To get a carnet, send your application with a recent photograph to the Settlements Office to which you are attached (members from the Council should send their application to Brussels Settlements Office) Further information is available on Europateam concerning both the holidays (http://www.europateam.cc.cec/guide/assmal/sante/themes.htm) and the reimbursements made by the sickness scheme (http://www.europateam.cc.cec/guide/assmal/remb/rembt.htm). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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